Kevin Lixfield considers himself a lucky man. The 70-year-old resident of Medford, New York is a U.S. Marine Corps veteran who has survived several tours in Vietnam, not to mention cancer and a liver transplant. His most recent bout of luck occurred in April 2021 when he had a stroke.
Lixfield was at home watching television when his stroke occurred. He said he didn’t realize it was happening until his wife, Philippa, returned home and asked him a question. “Nothing came out but garble. My brain knew what I wanted to tell her, but the words didn’t come out,” he recalled.
Philippa asked him if he was having a stroke, and he gave her a thumbs up in response. She immediately called 9-1-1. Lixfield, who had no other deficit besides aphasia, felt strong enough to walk out to the ambulance when it arrived, and was immediately transported. He was taken to Stony Brook University Hospital, a comprehensive stroke center, roughly 20 minutes away.
As a matter of protocol, Lixfield received non-contrast CT and CT angiography scans, but neither scan alerted the stroke care team that anything was amiss. “The CTA looked totally normal. You would never suspect that there was anything wrong by looking at it,” said Dr. David Fiorella, the interventional neuroradiologist who treated Lixfield.
Lixfield was next given a CT perfusion scan. Luckily, Stony Brook is equipped with the Rapid advanced imaging platform. The analyzation and processing done by the software made it very easy for Fiorella to see that his patient was indeed having a stroke by identifying the areas of the brain affected by reduced blood flow. Dr. Fiorella could see that Lixfield was suffering from a distal vessel occlusion—a blockage in an artery so small that it couldn’t be seen on other types of brain scans.
In Lixfield’s case, the area of the brain affected by this blood clot was very small, but very impactful, because it was in the region that controlled speech. “He had a severe clinical deficit (aphasia) even though the artery that occluded was very small. It was an area of volume of only 12 CCs, but it was an extremely important 12 CCs,” Dr. Fiorella said.
Based on the Rapid CTP results, Dr. Fiorella was able to determine that his patient would benefit from endovascular intervention, something that would not have been possible to assess without the use of Rapid, he said. A mechanical thrombectomy was performed and successfully removed the clot, restoring blood flow to the crucial area of the brain responsible for Lixfield’s speech.
Typically, this type of procedure is not an option for patients with small, distal vessel strokes. “Usually, patients like him get IV tPA if they are within the window of treatment, but if they are outside the window, like he was, they are just given oxygen and an aspirin. Whatever deficit they have, they just have to try and recover from it through rehab,” Dr. Fiorella explained.
Lixfield’s recovery was also very surprising in terms of how swift it was. He was able to speak the next day and now has virtually no remaining deficit. This good fortune is not lost on him. As he puts it: “I lucked out, and I’m lucky enough to know when I luck out.”